Public health and social measures employed in Timor-Leste with limited impact on COVID-19 transmission
| Public health intervention | Discussion of limitations |
| Restrictions on low-risk outdoor activities | For extended periods of mandatory home confinement, designed to limit community transmission of COVID-19, residents in Timor-Leste were not permitted to leave their place of residence for non-essential activities, including non-essential work, religious gatherings, education and exercise. These restrictions had a big impact on people’s lives and livelihoods. While the rationale for restricting indoor meetings and activities was strong, there is evidence that transmission is limited in outdoor, well-ventilated settings,45 and it is unlikely that restricting outdoor exercise had a meaningful impact on the rate of COVID-19 transmission in Timor-Leste. |
| Restrictions on funeral and burial practices | At the time of the first recognised COVID-19 related deaths, tight restrictions were put in place, that limited postmortem care of the body, the number of people who could attend the funeral of people who died with COVID-19 and the location of the burial. While placing limitations on large gatherings had a strong rationale, other aspects of the policy were very controversial, leading to public protests that probably posed an even greater risk to onward transmission of COVID-19 than traditional burial practices would have, especially given the low risk of SARS-CoV-2 transmission once the person is deceased.46 |
| Prolonged isolation of cases with persistent PCR positivity | Timor-Leste initially adopted the WHO policy regarding clearance from isolation,47 but was slow to change to an approach that did not require clearance PCR testing, even when international guidelines changed because of emerging evidence that individuals with COVID-19 were rarely infectious beyond day-10 of their illness.48 |
| School closures after community transmission established | School closures occurred in most countries around the world, but probably had limited impact on reducing COVID-19 transmission,49 while also significantly disrupting educational opportunities for children, who despite being the least likely to suffer severe morbidity or mortality from COVID-19, have been affected disproportionately by measures aimed at reducing transmission, including school closures.50 |
| The continuation of facility-based isolation of cases after community transmission was occurring | Facility-based isolation of cases was integral to the prevention of community transmission of COVID-19 in Timor-Leste in 2020. However, once community transmission was established in 2021, seroprevalence data suggest that a large proportion of the community was affected in a short time period,5 and it is likely that there were more people with undiagnosed COVID-19 in the community, than there were with known COVID-19 in isolation facilities. Mandatory facility-based isolation is expensive for the health system and provides a disincentive for people to be tested or seek medical attention. Once community transmission was established, a more rapid shift to supported home-based isolation would have been more effective. |